Provider Demographics
NPI:1760694582
Name:RADEN, LAUREN (OTRL)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:RADEN
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9815 CARLSDALE DRIVE
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569
Mailing Address - Country:US
Mailing Address - Phone:732-261-2788
Mailing Address - Fax:
Practice Address - Street 1:1962 VANDOLAH RD
Practice Address - Street 2:
Practice Address - City:WAUCHULA
Practice Address - State:FL
Practice Address - Zip Code:33873-8726
Practice Address - Country:US
Practice Address - Phone:863-767-4411
Practice Address - Fax:863-773-9293
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT11681225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation